ideasIdea
A statutory minimum share of public trial money for surgery and radiotherapy
Surgery and radiotherapy cure more people than drugs but get a fraction of trial funding because there is no company sponsor. A rule would guarantee them a fixed share of public trial money.
Public trial funders (NCI's NCTN, NIHR, EU programmes) would set a floor, for example 25%, for trials whose primary intervention is surgical, radiotherapeutic, interventional or a care-pathway change. The floor is justified because private sponsors fund almost all drug phase 3s but essentially no non-drug ones, so public money should preferentially cover the market failure. The quota would be paired with core funding for surgical and radiotherapy trials units and quality assurance.
Hypothesis
A 25% floor doubles the number of adequately powered randomised surgical and radiotherapy trials started per year within five years, without reducing the total number of practice-changing results per public dollar.
Rationale
Published audits show surgery and radiotherapy receive a small single-digit share of cancer research funding despite delivering around half of cures; where dedicated infrastructure exists (UK CTRad, TROG, the German Hodgkin Study Group) these fields have produced practice-changing trials at low cost.
What would test it
Audit one funder's portfolio by intervention type, apply the floor for one funding cycle, and count trials started, completed and practice-changing five years later against the prior cycle.
Maturity
speculative
Who has to act
policy
Cost to try
Large (over $50M)
Years to first evidence
5
Bottlenecks it attacks
- Funding follows fashion, not burden · Money goes to the cancers and questions that are easy or popular, not the ones that kill most or where a dollar would do most.
- Surgery and radiotherapy cure most, get least · Surgery and radiotherapy cure more people than drugs do, but attract a fraction of the research investment.